SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Vered ABITBOL-SELINGER
Coup de coeur :
 
 
The American Journal of Gastroenterology
  2017/08  
 
  2017 Aug;112(8):1311-1319.  
  doi: 10.1038/ajg.2017.183.  
 
  Appendectomy and the Risk of Colectomy in Ulcerative Colitis: A National Cohort Study  
 
  Myrelid P, Landerholm K, Nordenvall C, Pinkney TD, Andersson RE  
  https://www.ncbi.nlm.nih.gov/pubmed/28653667  
 
 

Abstract

OBJECTIVES:

Ulcerative colitis (UC) is a chronic inflammatory disease usually responding well to anti-inflammatory drugs but many patients will still need colectomy. Appendectomy is associated with a lower risk of later developing UC. We aimed to assess the longitudinal relationship between appendectomy, appendicitis, and disease course in UC patients.

METHODS:

A national cohort of UC patients with a diagnosis in 1964-2010 was identified from the Swedish National Patient Register that also provided information regarding appendicitis and/or appendectomy before or after the UC diagnosis. The risk for colectomy and UC-related hospital admissions was evaluated.

RESULTS:

Among 63,711 UC patients, 2,143 had appendectomy and 7,690 underwent colectomy. Appendectomy for appendicitis before 20 years of age and for non-appendicitis at all ages before UC diagnosis was associated with a lower risk of colectomy (hazard ratio (HR) 0.44, 0.27-0.72 and HR 0.62, 0.43-0.90, respectively), and fewer hospital admissions (incidence rate ratio (IRR) 0.68, 95% confidence interval (CI) 0.64-0.73 and IRR 0.54, 0.47-0.63, respectively). Appendectomy for appendicitis after the UC diagnosis was associated with a higher risk of colectomy (HR 1.56, 1.20-2.03), whereas no such association was found for other pathology (HR 1.40, 0.79-2.47).

CONCLUSIONS:

Appendectomy early in life and before developing UC is associated with a lower risk of colectomy as well as UC-related hospital admissions. Appendectomy for appendicitis after established UC appears associated with a worse disease course, with an increased rate of subsequent colectomy.

 

 
Question posée
 
L’appendicectomie modifie-t-elle l’évolution de la RCH ?
 
Question posée
 
L’appendicectomie à un âge jeune (<20ans) et avant le diagnostic de RCH est associée à un risque faible de colectomie. L’appendicectomie pour appendicite après le diagnostic de RCH est associée à une évolution péjorative de la RCH et à un risque accru de colectomie.
 
Commentaires

Les relations entre appendicectomie et RCH sont débattues depuis de nombreuses années. Cette étude rétrospective a évalué une très large population issue de la base de données nationale suédoise.

 
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